People with psoriatic arthritis may have symptoms of both psoriasis and arthritis. The condition causes widespread inflammation that impacts many systems in the body from the immune system to the digestive system.
Here, we explore the many effects of PsA on the body, including on a person's vision, digestion, breathing, and movement. We also discuss treatment options for the condition.
Image credit: Stephen Kelly, 2019
The skin, hair, and nails are also known as the integumentary system.
People with PsA tend to experience the classic symptoms of psoriasis, including rough, red patches on the skin and thickened nails.
Psoriasis causes these effects by speeding up the life cycle of skin cells. New cells move to the outer layer of skin in a few days rather than weeks.
Doctors think this process occurs because the body tries to heal a wound or fight an infection that is not there.
These new cells rapidly build up on the skin to form the itchy, scaly patches that characterize psoriasis. The skin may feel warm and turn red due to widened or dilated blood vessels. The patches may sometimes be painful.
When psoriasis affects the skin on the scalp, the flakes may be mistaken for dandruff or seborrheic dermatitis.
PsA usually impacts the joints closest to the nail in a person's fingers and toes. Nails can turn thick, rough, and rigid. They discolor or develop pits. In some cases, the nail can separate from the nail bed, known as onycholysis.
PsA occurs when the immune system mistakenly launches an attack on the body.
Along with skin changes, this abnormal immune reaction causes inflammation of the joints, affecting the musculoskeletal system in several ways.
Inflammation causes pain, stiffness, and swelling in one or more joints, making it difficult to move the joints. Fingers and toes may swell and take on a sausage-like appearance known as dactylitis.
People with PsA will often experience neck and back pain and have difficulty bending their spine. When these symptoms occur, it is known as spondylitis.
How does it affect cartilage?
The cartilage at the end of the bones can become damaged by long-term, chronic inflammation. The bones eventually rub against each other, causing further pain and joint damage. Inflammation can also lead both to bone erosions and extra bone growth.
In addition to bone damage, chronic inflammation affects the surrounding ligaments and tendons.
As PsA is an autoimmune condition, it affects the body's immune functioning.
When the immune system functions normally, it kicks into action to fight bacteria and viruses. Autoimmune conditions cause the body to turn on itself and attack its own structures when no invaders are present.
In PsA, the body attacks the joints, tendons, and insertion points of tendons and ligaments (entheses), and skin in the case of PsA.
Researchers do not fully understand why this happens. They think some bacterial infections, including strep throat or skin bacteria, may trigger PsA.
Uveitis is more common in females, and up to 17 percent of children with PsA have uveitis. In comparison, just 0.1 percent of Americans who do not have PsA will get uveitis.
Psoriasis-related eye conditions can cause a loss of vision, in rare cases, if not diagnosed early.
There is a link between inflammatory bowel disease (IBD) or colitis disease and PsA because inflammation underlies both conditions.
People with PsA are at substantial risk of developing IBD disease in comparison to the general population, according to research. Other studies suggest that psoriasis is eight times more common in people with Crohn's disease.
If inflammation spreads to the lungs, it can cause a condition called interstitial lung disease. However, interstitial lung disease has a stronger association with rheumatoid arthritis, which is another form of inflammatory arthritis, than with PsA or psoriasis.
Nevertheless, inflammation in the lungs causes scarring over time. The scarring or fibrosis is irreversible and eventually affects breathing and the ability to get enough oxygen into the body. Other symptoms include coughing and fatigue.
According to the American College of Cardiology, cardiovascular disease is a major cause of illness and death in people with chronic inflammatory disorders, such as psoriasis and rheumatoid arthritis.
In addition to causing physical symptoms, having PsA can impact mental and emotional health. People with the condition may experience anxiety and depression as they worry about their health, their future, and their family.
Living with chronic pain may cause people to exhibit symptoms of depression, such as a loss of interest in things they once enjoyed and persistent sadness.
Psoriasis and PsA may also impact self-esteem and cause feelings of embarrassment, especially when treatments do not adequately manage symptoms.
There is no cure for PsA, but treatment can address both the symptoms and the underlying cause.
Emerging treatments show promise for reducing the severity of symptoms and frequency of flares. They may also slow the progression of PsA and prevent permanent damage.
Current guidelines recommend a type of treatment called biologic therapy for people with a new diagnosis of PsA. These drugs are not suitable for everyone, however, and they can have adverse effects.
If a person cannot use a biologic, a doctor can recommend an alternative, such as an oral small-molecule drug or a disease-modifying antirheumatic drug.
A robust treatment regimen can control symptoms and improve quality of life.
Treatment options for symptom flares include:
- Medication, primarily nonsteroidal anti-inflammatory drugs or NSAIDS, to control pain, treat skin symptoms, and prevent joint damage.
- Steroid injections to ease inflammation.
- Joint replacement surgery to replace damaged joints.
Lifestyle changes and home remedies are also beneficial for people with PsA. These include:
- changing the way everyday tasks are done to protect joints
- maintaining a healthy weight
- engaging in regular exercise
- resting and relaxing when necessary
- eating an anti-inflammatory diet
- seeking support from others, such as family, friends, or a therapist
PsA results in symptoms of both arthritis and psoriasis. It causes widespread, chronic inflammation that affects the joints, entheses, the skin, and other body systems.
Although there is no cure for the condition, people can improve their quality of life by managing their symptoms by finding the correct medical treatments and making lifestyle changes.